A healthy rational philosophy: At odds with optimum physical health?

Back in 1994 Albert Ellis wrote The sport of avoiding sports and exercise: A Rational Emotive Behavior Therapy perspective. He was not a fan of exercise:

In regard to the sport of avoiding sports and exercise, I am something of a reformed crook. I used to gleefully quote James Thurber: ‘Whenever I get an urge to exercise, I lie down until it goes away” (p.248).

Ellis continued to avoid exercise even when he was diagnosed with diabetes and knew that exercise could help him manage the condition. He only began to incorporate regular movement into his routine later in life, when he developed back pain, sciatica, and rheumatism, which affected his ability to sit and write, or stand and talk. He doesn’t mention developing any enjoyment of exercise, simply less avoidance of it.

The same journal contained Jim Taylor’s response to Ellis, which fruitfully expanded on areas where REBT could be overlaid with what was known about exercise and sport participation. Taylor did, however, consider that Ellis “does not place enough emphasis on replacing irrational beliefs with more positive beliefs about the self and exercise/sport participation” (p.264).

Taylor considered Ellis’ proposed rational disputation to the irrational belief that “exercise is awful” (exercise might be “inconvenient, but hardly awful”) to be inadequate and inappropriate (because inconvenience can be enough to prevent someone from exercising). Taylor proposed that this disputation could be extended, by encouraging a client to see the positive benefits of exercise (“Hey, maybe there are some good things about exercise/sport”) that would be more motivating to initiate exercise (p.265).

A common misunderstanding about REBT

Taylor’s criticism stems from one (of several) common misunderstandings about what REBT is trying to achieve, which is that in helping someone to give up their negative beliefs it is necessary to help them shift to more positive beliefs. In fact, REBT is based on realistic thinking, which leads to more realistic, less distressing emotional reactions to those things.

I’ll try to illustrate this misunderstanding with an example from a client, Janine. Here’s an ABC we worked through for her exercise avoidance:

abc1

In REBT we want to help our clients act less self-defeatingly and make progress towards their goals, as a result of experiencing less emotional distress when encountering unwanted, un-preferred adversities in their pursuit of those goals. A misunderstanding can arise when considering how one goes about helping people disturb themselves less about these adversities.

Taylor suggested we tell (or remind) exercise-avoiders about the positive reasons to exercise, as this can be more motivating. Not only is this potentially going to get us caught up in trying to ‘correct’ the client’s view of the situation which can lead to resistance, in REBT the core work we do to reduce emotional distress is not by encouraging clients to ‘think of the benefits’ or to reframe the situation at A in a more positive light.

Instead, we work on the core cognitive vulnerabilities, the client’s irrational beliefs, which underpin their emotional distress. Using a variety of tools, we help them to develop more flexible, rational, beliefs so that their emotional responses to adversities are less debilitating, and they can continue to take the necessary actions towards their goals.

abc2

So, when I was working with Janine, our goal was to move her towards feeling concerned rather than anxious about the fact that people might look at her and judge her, and if it transpired that it actually happened (which it does), to feel disappointed and annoyed rather than miserably sad and unhealthily angry about that. This arose from a change in her beliefs, as she learnt to prefer that people did not look or judge, but not demand that it be so, and to not consider it to be so misery-inducing and so intolerable if it happened that she would need to flee the gym, never to return. Ultimately, this would make it more likely that Janine would initiate exercise, and continue to even if it felt emotionally uncomfortable at times.

So, progress in REBT is not from negative (e.g., anxiety and self-consciousness about exercising) to positive (e.g., excitement and delight about the imagined or actual workout, and a cavalier, confident attitude about how other people might be evaluating us). That would be quite a leap. I hope Janine will eventually feel unconcerned or neutral about what other people think, but even before that happens (and if it never does) she can start exercising now, build confidence and self-efficacy, and practice her new thinking in the real world.

But is Taylor right?

Is a healthy rational philosophy, which is the goal of REBT, at odds with the goals of sport and exercise psychology – considering what we know about the risks of being overweight, and the physical and mental health benefits of eating well, exercising, and maintaining a healthy weight? Am I only doing half a job if ‘all I do’ is help Janine accept that exercise (and improved nutrition) are ‘inconvenient necessities’ on the path to achieving better health?

Taylor’s suggestion that we help our clients to consider more of the benefits of exercise, involves work at A – helping reluctant exercisers to reframe exercise as not even an adversity in the first place; to consider how much fun exercise can be, how proud and satisfied they will feel during or after they exercise, how exercise can improve their energy, sleep, wellbeing, and mood.

Albert Ellis was not motivated enough to exercise when he was diagnosed with diabetes, but was more so when he realised that his continuing to not-exercise was affecting his work, causing pain or reducing mobility. The pursuit of health for health’s sake is often not sufficiently motivating for most people, especially people who have typically avoided or do not enjoy healthy pursuits. Instead of imposing our reasons (even those reasons we think are obvious and true) upon our clients, we can collaborate with them to locate the unique reasons and values that make it important for them to be more active, or eat better. This helps to develop a discrepancy between their current and their preferred situations, which can motivate them to initiate change. However, there will still be vulnerabilities that will disrupt the maintenance of that behaviour if the client has not learned how to tolerate more discomfort and frustration around healthy eating and exercise, or experiences shame or anxiety about themselves in an exercise setting.

So, rather than starting out by encouraging clients to consider the positive benefits of exercise (which they are probably aware of anyway – as smokers are aware of the risks of smoking) we can help them to be more physically active (if they want to be!) via REBT, through the processes of rational disputation, putting the awfulness of exercise into perspective, helping them to become better at tolerating the discomfort of exercising, and practicing unconditional self-acceptance of their body and (lack of) competence in the exercise context. Eventually we hope that they will start to experience some of those positive benefits of exercise for themselves, which will reinforce and help them maintain a new exercise habit. The horse before the cart. Even so, affective responses to exercise vary greatly between individuals (see here and here), and some individuals don’t enjoy exercise, might never learn to like it, and will always prefer to avoid it. REBT can still help these folks to be a bit more active.

As a type of psychotherapy, REBT was developed and is used (successfully) to help people with a wide range of clinical mental health difficulties and behavioural disorders. But some critics of REBT can consider the notion of viewing certain situations as adversities, continuing to dislike and preferring not to have to face these adversities, and with a goal of feeling less intense (but still negative) emotions about them, to be somewhat pessimistic. This might go against the grain of the philosophy for practice of some sport and exercise psychologists and seem counterintuitive to our focus on performance or health. Let’s keep the discussion going about how REBT can be applied to our discipline.

Physician, heal thyself

I use REBT as a self-development tool to identify the demands I place upon myself and to develop a more resilient response set to (real and anticipated) adversities. But, although I strongly prefer to be a healthy weight I have not (yet) utilised REBT to address my weight gain over the past few years. I do practice more unconditional self-acceptance – I am a fallible human being, currently residing in a larger, unhealthier, body – and am consequently far less concerned about or preoccupied with my physical appearance as I was 10 years ago. One side-effect of this is a reduction in the drive I once had to spend time ‘working on’ my physical appearance – which has had the consequence that I am not only larger now, but less healthy too. I do wonder whether my weight might affect my therapeutic relationships and my clients’ outcomes (when I am working with overweight clients). I welcome the thoughtful opinions of other practitioners on this issue.

What I like about REBT is that it doesn’t send me on a wild goose chase for silver linings. It allows me to feel negative emotions about situations that I dislike, but helps me dial down those emotions so that they do not disturb me too much and so that I do not avoid what needs to be done. This helps me to maintain momentum through a present focus, neither ruminating on the past nor worrying too much about the future. My mantra:

Where Zen says “He who wants nothing has everything”, REBT says “She who sticks to wants and does not demand gratification of those wants will probably be able to enjoy goal-directed activities, not all of which will result in success” (Byrne, 2008).

 

helen o'connor

 

 

 

 

 

Helen is a Chartered Psychologist working privately and in the public sector. She focuses on health behaviour change, addictions and substance misuse (including PIEDs). Helen is friendly and always happy to answer any questions. She tweets as @psycurious.

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